Provider Demographics
NPI:1932723764
Name:CHUKWUNEKE, PRINCESS UJUM
Entity Type:Individual
Prefix:
First Name:PRINCESS
Middle Name:UJUM
Last Name:CHUKWUNEKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 WINCHESTER AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3502
Mailing Address - Country:US
Mailing Address - Phone:516-943-4921
Mailing Address - Fax:
Practice Address - Street 1:400 W CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3646
Practice Address - Country:US
Practice Address - Phone:203-785-2389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT153486163W00000X
CT9025363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty